Abstract: Understating the rubrics does not just perceive the literal meaning of the symptoms but should be a logical correlation of the Symptoms with that of Clinical Medicine.
A Repertory is the Index of symptoms from the Proving. The Repertory’s author describes these symptoms and puts them in a particular format depending on the Logic and/or Philosophy the author follows, for example Boenninghausen or Kent. We are also trained to handle those Repertorial Rubrics pursuing the same Logic or Philosophy.
Since Repertory is the only source of information about the Relative value of symptoms of a medicine from that of proving it should be understood even beyond the underlying Logic or Philosophy. That is many rubrics are not explored in their original value since now. So it is the time to review our-self the Repertorial Rubrics to find their newer dimensions.
In such an inquiry we can notice that many Rubrics are accurately indicating the Clinical Presentations of Various Diseases and even their Modern Classification. Now it is in our hands to interpret Rubrics with that of Clinical Medicine. Here I am quoting some interesting rubrics as examples and how they become an “Index” to Clinical Medicine.
We all know Seizure is a paroxysmal event due to abnormal, excessive, hypersynchronous discharges from an aggregate of central nervous system neurons. Depending on the distribution of discharges, this abnormal activity can have various manifestations, ranging from dramatic convulsive activity to experiential phenomena not readily discernible by an observer. Based on clinical presentations seizures can be classified into various types. Now we can see how the seizure and its types are represented as Rubrics using Synthesis Repertory 9.0.
Common Seizure Presentations
| S.No | Rubrics from Synthesis Repertory | Type of seizure | Explanation |
| · Generals, convulsions, children, in · Mind, unconsciousness, frequent spells of unconsciousness · Mind, absent minded, epileptic attack before · Mind, absent minded, periodical, short lasting attacks of absentmindedness · Mind, absent minded, dreamy · Generals, convulsions, sudden · Generals, convulsions, consciousness, without · Generals, convulsions, short attacks · Generals, convulsions, epileptic, aura, face, chewing motion · Face, chewing motion of the jaw, epilepsy, before an attack of · Eye, twitching, lids, epileptic convulsions, before · Extremities, convulsions, hand · Extremities, convulsions, hand, clonic · Generals, convulsions, epileptic, aura, hands, in · Generals, convulsions, begin in, hands · Extremities, jerking, fingers, epilepsy · Head, motions of head, convulsive |
Absence seizure / Petit Mal seizure |
Usually begin in childhood or early adolescence. Characterized by sudden, brief lapses of consciousness Accompanied by subtle, bilateral motor signs such as rapid blinking of the eyelids, chewing movements, or small-amplitude, clonic movements of the hands. Since the clinical signs of the seizures are subtle, the first clue to absence epilepsy is often unexplained “daydreaming” |
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| · Generals, convulsions, epileptic · Generals, convulsions, sudden · Generals, convulsions, tonic · Face, convulsions, spasms, muscles · Face, convulsions, spasms, masseter muscles · Face, convulsions, spasms, jaw · Mouth, biting, tongue, convulsions, during · Generals, convulsions, epileptic, during epileptic convulsions, complaints, larynx, spasms in · Generals, convulsions, cyanosis, with · Cough, convulsions, with, larynx in · Respiration, arrested, convulsion, during · Respiration, difficult, convulsion, during · Respiration, rattling, convulsion, during · Mouth, mucus, ropy, epileptic convulsions, during · Mouth, salivation, convulsions, with · Mouth, spasms, accompanied by, froth · Throat, gurgling, esophagus is, convulsion, during · Mind, shrieking, convulsions · Mind, moaning, convulsion, in · Mouth, biting, tongue, convulsions, during · Generals, convulsions, epileptic, during, epileptic complaints, palpitation, irregular · Generals, pulse, frequent, convulsions, during · Generals, convulsions, epileptic, during, epileptic convulsions, complaints, pupils, dilated · Generals, convulsions, epileptic, after, epileptic convulsions, complaints, unconsciousness · Generals, convulsions, epileptic, after, epileptic convulsions, complaints, headache · Generals, convulsions, epileptic, after, epileptic convulsions, complaints, prostration · Generals, convulsions, urination, involuntary Rectum, involuntary stool, convulsion, during |
Generalized, Tonic – Clonic Seizures / Grand Mal seizure |
Usually begins abruptly without warning. The initial phase of the seizure is usually tonic contraction of muscles throughout the body, accounting for a number of the classic features of the event. Tonic contraction of the muscles of expiration and the larynx at the onset will produce a loud moan or “ictal cry.” Respirations are impaired, secretions pool in the oropharynx, and cyanosis develops. Contraction of the jaw muscles may cause biting of the tongue. A marked enhancement of sympathetic tone leads to increases in heart rate, blood pressure, and pupillary size. After 10–20 s, the tonic phase of the seizure typically evolves into the clonic phase, produced by the superimposition of periods of muscle relaxation on the tonic muscle contraction. The periods of relaxation progressively increase until the end of the ictal phase, which usually lasts no more than 1 min. The postictal phase is characterized by unresponsiveness, muscular flaccidity, and excessive salivation that can cause stridorous breathing and partial airway obstruction. Bladder or bowel incontinence may occur at this point. |
Specific Seizure Presentations
| S.No | Rubrics from Synthesis Repertory | Type of seizure | Explanation |
| 1. | Generals, convulsions, alternating with, relaxation of muscular system | Akinetic / Atonic seizure |
Consists of a brief lapse in muscle tone |
| 2. | · Generals, convulsions, noise, from · Generals, convulsions, epileptic, aura, ear noises · Generals, convulsions, epileptic, aura, auditory complaints |
Audiogenic seizure / Startle seizure |
Precipitated by loud / sudden noises |
| 3. | · Generals, convulsions, epileptic, during epileptic convulsions, complaints, heart, complaints of the · Generals, convulsions, epileptic, during epileptic convulsions, complaints, palpitation, irregular · Chest, congestion, heart, convulsions, in |
Autonomic seizure |
Characterized by objectively documented dysfunction of the autonomic nervous system, usually involving cardiovascular system. |
| 4. | · Generals, convulsions, clonic · Generals, jerking, convulsions, as in |
Clonic seizure |
Characterized by repetitive rhythmic jerking of all or part of the body |
| 5. | · Generals, convulsions, touched, when · Generals, convulsions, brilliant objects, from · Generals, convulsions, epileptic, aura, visual complaints |
Complex precipitated seizure / Sensory precipitated seizure / Reflex seizure |
Reflux initiated by specialized sensory stimuli or certain visual pattern. |
| 6. | · Mind, fear, convulsions, with · Mind, excitement, convulsions, with · Mind, dream, as if in a, convulsions, after |
Complex partial temporal lobe seizure |
Intense pleasure or fear ushering in the attack; sense of loss of personal or environmental reality |
| 7. | · Generals, convulsions, clonic alternating with tonic · Generals, convulsions, tonic |
Convulsive seizure |
With clonic or tonic-clonic motor activity |
| 8. | Generals, convulsions, injuries from, head of the | Early post traumatic seizure | Due to cranio-cerebral trauma |
| 9. | Generals, convulsions, epileptic | Epileptic seizure | Seizure caused by epilepsy |
| 10. | Generals, convulsions, heat (fever), during the | Febrile seizure |
Associated with fever |
| 11. | · Face, convulsions, spasms · Mouth, convulsions · Chest, convulsion · Back, convulsions · Extremities, convulsions · Extremities, convulsions, single parts · Extremities, convulsions, tonic, single parts |
Focal motor seizure |
Simple partial seizure with localized motor activity |
| 12. | · Mind, laughing, epileptic convulsion · Mind, laughing, sardonic, epileptic convulsion, during · Generals, convulsions, laughing, from |
Gelastic seizure |
Characterized by bursts of involuntary laughter or giggling |
| 13. | · Generals, convulsions, isolated groups of muscles, of · Face, convulsions, spasms, extending to, limbs · Extremities, convulsion, lower limbs, extending to, upper limbs · Extremities, convulsion, foot, extending to, knees · Generals, convulsions, begin in below, extending to upwards · Generals, convulsions, begin in center, extending to circumference · Generals, convulsions, epileptic, aura, hands in, extending to body · Generals, convulsions, epileptic, aura, solar plexus from, extending to, chest |
Jacksonian seizure |
Motor seizure that initially involves one part of the body and then progressively spreads to other parts of the body |
| 14. | Generals, convulsions, cough, after | Laryngeal seizure | Precipitated by coughing |
| · Generals, convulsions, tonic, single parts · Generals, convulsions, isolated groups of muscles, of |
Myoclonic seizure |
Sudden contractions of muscle fibers, muscles, or groups of muscles |
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| 16. | Generals, convulsions, night | Nocturnal seizure | Only at night |
| 17. | Generals, convulsions, epileptiform | Nonepileptic seizure | Any behavior that resembles a seizure, but is not epileptic |
| 18. | · Vision, loss of vision, convulsion, after · Vision, loss of vision, convulsion, before · Vision, diplopia, convulsions, with |
Occipital lobe seizure |
Originate from occipital lobe resulting in visual abnormalities |
| 19. | · Generals, convulsions, bright light, from · Generals, convulsions, shining objects from, mirror; reflected light from water |
Photogenic seizure / Pattern sensitive seizure |
Reflux initiated by light |
| 20. | · Generals, convulsions, begin in, abdomen · Generals, convulsions, begin in, arm · Generals, convulsions, begin in, back · Generals, convulsions, begin in, calf muscles, of · Generals, convulsions, begin in, extremities · Generals, convulsions, begin in, eye · Generals, convulsions, begin in, face · Generals, convulsions, begin in, fingers · Generals, convulsions, begin in, hands · Generals, convulsions, begin in, head · Generals, convulsions, begin in, legs · Generals, convulsions, begin in, throat · Generals, convulsions, begin in, toes |
Primary generalized seizure |
Begin as partial seizures then spread diffusely throughout the cortex |
| 21. | · Generals, convulsions, runs before convulsions · Generals, convulsions, motion, aggravation |
Procursive seizure |
Initiated by running or whirling |
| 22. | Generals, convulsions, hysterical | Psyogenic seizure | Resembles an epileptic seizure, but is related to psychiatric disturbance |
| 23. | Generals, convulsions, epileptic, psycomotor seizures | Psycomotor seizure | Characterized by psychic manifestation |
| 24. | Generals, convulsions, one side, accompanied by, speech, wanting | Rolandic epilepsy | With arrest of speech and muscular contractions of the side of face and arm |
| 25. | · Head, drawn, backward, convulsion, in · Head, turned, left in, convulsions, to · Eye, turned, convulsions, during · Eye, turned, downward, convulsions, during · Eye, turned, upward, convulsions, during · Generals, convulsions, epileptic, during epileptic convulsions, complaints, eyes, downwards, turned · Generals, convulsions, epileptic, during epileptic convulsions, complaints, eyes, upwards to right, turned · Generals, convulsions, epileptic, during epileptic convulsions, complaints, eyes, wrinkling of eyes · Extremities, convulsions, foot · Extremities, convulsions, foot, tonic · Generals, paralysis, one side, convulsions, after |
Simple partial motor seizure |
Focal motor symptom correlates with the area of their representation in the motor cortex. Examples: Rotation of head and eyes contra-laterally; tonic foot movements ipsi- laterally; etc., |
| 26. | Extremities, numbness, leg, convulsion, before | Simple partial sensory seizure | Emanating from the sensory cortex |
| 27. | · Generals, convulsions, touched when · Generals, convulsions, touched when, slight touch |
Sensory seizure |
Initiated by a somato-sensory phenomenon |
| 28. | · Generals, convulsions, sleeplessness, with or after · Generals, convulsions, epileptic, aura, sleeplessness |
Somnabulic seizure |
Post-ictal automatism in which the patient runs or walks |
| 29. | · Generals, convulsions, tonic · Generals, convulsions, tetanic rigidity |
Tonic seizure |
Characterized by a sustained increase in muscle tone |
| 30. | · Generals, convulsions, epileptic, aura (before epileptic convulsions) · Generals, convulsions, epileptic, aura, vertigo |
Torando Seizure |
With an aura of severe vertigo or a feeling of being drawn up into space |
| 31. | · Eye, turned, convulsions, during · Head, drawn backwards, convulsions, in |
Versive seizure |
Characterized by sustained, forced conjugate ocular and cephalic deviation |
| 32. | · Generals, convulsions, vomiting, during · Generals, convulsions, diarrhea, with |
Visceral seizure |
Due to visceral response to a focal irritation in cerebral cortex manifested with vomiting and / or Diarrhoea |
Conclusion
Repertory is a multifaceted tool which can be explored and utilized successfully under versatile vistas. One such panoramic view is explained above with few examples.
“Rubrics are not just Symptom Complex but
Rubrics are the Index to Clinical Medicine”
References:
- Dennis L.Kasper, Eugene Braunwald, Anthony S.Fauci, Stephen L.Hauser, Dan L.Longo, J.Larry, Harrison’s Principles of Internal Medicine, Seventeenth Edition, Volume-2, The McGraw-Hill Companies, Inc., Chapter 363.
- David A. Warrell, Timothy M. Cox, John D. Firth, Edward J., J R., M.D. Benz, Oxford Textbook of Medicine, 4th edition, Oxford Press, Chapter 24.13.3.
- http://en.wikipedia.org/wiki/Seizure_types
- Stedman’s Medical Dictionary, Lippincott Williams & Wilkins, 28th Edition, 2006.
- Frederik Schroyens, Synthesis Repertory 9.0, Homeopathic Book Publishers, 2002.
